- Perceived family functioning and family resilience were negatively correlated with anxiety, depression, and multidimensional sleep problems in children and adolescents with cancer.
- Perceived family functioning retained a direct association with fewer sleep problems after accounting for depression and anxiety.
- Depression and anxiety significantly mediated associations between family protective factors and sleep problems, suggesting combined family and psychological interventions to improve sleep.
Cancer Med. 2026 Sep;15(9):e72248. doi: 10.1002/cam4.72248.
ABSTRACT
BACKGROUND: Multidimensional sleep problems are prevalent among children and adolescents with cancer. Although perceived family functioning and family resilience are known to be associated with sleep problems, the contributions of depression and anxiety remain unquantified.
AIMS: To examine associations of perceived family functioning and family resilience with multidimensional sleep problems and quantify indirect associations through depression and anxiety among Chinese children and adolescents undergoing active cancer treatment.
METHODS: This cross-sectional study used baseline data from 518 patients aged 7 to < 18 years in the Chinese Childhood Cancer Survivorship Wellbeing Cohort. Perceived family functioning and family resilience were assessed using the Family APGAR Questionnaire and Family Hardiness Index, respectively. Depression and anxiety were measured using the pediatric PROMIS scales, and multidimensional sleep problems were assessed using the BEARS Sleep Screening Scale. A mutually adjusted, multiple-predictor parallel mediation model used 5000 bootstrap resamples and adjusted for sociodemographic and clinical covariates. A parallel indirect-association sensitivity analysis with the BEARS summed score modeled as a Poisson count outcome was performed.
RESULTS: Perceived family functioning was negatively correlated with anxiety (r = -0.341), depression (r = -0.355), and sleep problems (r = -0.240), and family resilience was negatively correlated with anxiety (r = -0.283), depression (r = -0.311), and sleep problems (r = -0.222; all p < 0.001). After depression and anxiety were included, perceived family functioning remained directly associated with fewer sleep problems (B = -0.061, p < 0.05), with a significant total indirect association (B = -0.048, bias-corrected 95% bootstrap CI: -0.071 to -0.028). Family resilience showed a nonsignificant direct association but a significant total indirect association (B = -0.010, bias-corrected 95% bootstrap CI: -0.016 to -0.004).
CONCLUSIONS: Depression and anxiety showed significant indirect associations between family protective factors and sleep problems. Interventions addressing family dynamics and psychological distress may improve sleep outcomes.
PMID:42750168 | DOI:10.1002/cam4.72248
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